STATE OF FLORIDA BOARD OF DENTISTRY DEPARTMENT OF HEALTH, PETITIONER, v. CASE NO: 2016-16543 LORYN R. MERRILL, D.D.S., RESPONDENT. / ADMINI TIVE CO NT COMES NOW Petitioner, Department of Health, by and through its undersigned counsel, and files this Administrative Complaint before the “Board of Dentistry against Respondent, Loryn R. Merrill, D.D.S., and in support thereof alleges: 1. Petitioner is the state department charged with regulating the practice of dentistry pursuant to Section 20.43, Florida Statutes; Chapter 456, Florida Statutes; and Chapter 466, Florida Statutes. 2. At all times material to this Complaint, Respondent was a licensed dentist within the State of Florida, having been issued license number DN 17817. 3. Respondent's address of record is 1209 East Cumberland Avenue, Apartment 507, Tampa, Florida 33602. 4. On or about October 29, 2013, Patient FH. presented to Respondent's practice for an implant consultation. 5. According to the clinical record, Patient F.H. had a panoramic radiograph taken at another dental practice and Respondent noted the need to acquire a copy. 6. On that date, Respondent developed a treatment plan which - called for the extraction of Patient F.H.’s remaining maxillary teeth and placement of 4-6 implants “depending on bone,” with four months of time provided for the implants to integrate. Patient FH. was to wear a temporary full denture in the interim. 7. On or about November 7, 2013, Patient FH. returned to Respondent's practice to continue with the consultation. According to the clinical record, Patient FH. inquired about an option to place a fixed implant hybrid denture, but Respondent instead planned to provide a removable over denture due to “limitations in bone.” 8. The minimum standard of performance in diagnosis and treatment in the practice of dentistry requires a practitioner to utilize appropriate diagnostic imaging and testing when developing a treatment plan. 9. Respondent developed her treatment plan without the use of a panoramic radiograph or full mouth series of radiographs. 10. According to the clinical record, Respondent did not take a panoramic radiograph of Patient F.H. until December 6, 2013. Her note for that date remarked that she would have “more info on bone quality on day of [surgery],” which she indicated may change the treatment plan. 11. On or about December 17, 2013, Respondent extracted Patient F.H.’s teeth numbers 2, 4, 6, 9, and 10, performed a sinus lift, placed bone grafts, and placed six maxillary implants. 12. Respondent's record for that date does not contain any findings regarding Patient F.H.'s bone levels at the time of the surgery or any suggested alterations to the proposed treatment. 13. The minimum standards of performance in diagnosis and treatment in the practice of dentistry requires a practitioner to identify any notable radiographic findings and evaluate whether further testing or treatment is needed. 14. A periapical radiograph taken on December 17, 2013, showed a radiolucency over one of the implants in the area of teeth numbers 9 and 10. 15. The presence of a periapical radiolucency in this area may indicate a pathology or possible perforation. 16. The radiolucency is present in subsequent radiographs taken during Respondent’s treatment of Patient FH. 17. Respondent did not identify or provide any evaluation of the radiolucency during her treatment of Patient F.H. 18. According to the clinical record for December 19, 2013, Respondent noted that Patient FH. could not tolerate the temporary denture due to a sensitive gag reflex. 19. According to the clinical record for that date, Respondent provided Patient FH. with the “option” of removing the palate portion of the temporary denture. She noted in the record, however, that she warned Patient FH. that the denture would not be retentive with the palate removed. 20. The palate of the implant-supported denture bears the pressure of the biting forces. If it is removed, this places additional force on the implants, which can lead to movement and compromise implant integration. | 21, The minimum standard of performance in diagnosis and treatment in the practice of dentistry requires a practitioner make appropriate adjustments to dental prostheses so as to not compromise the dental treatment. | 22. When Respondent removed the palate of Patient F.H.’s denture, she affected the stability of the recently-placed implants and compromised their integration. 23. The minimum standard of performance in diagnosis and treatment in the practice of dentistry requires a practitioner to adequately monitor the progress of a patient following implant placement and provide appropriate treatment should complications occur. 24. On or about January 6, 2014, Respondent performed a post- operative check on Patient F.H.’s dentures. She noted in the clinical record that he was healing within normal limits, but that Patient FH. reported some discomfort where Respondent performed the sinus lift. 25. At an appointment a few days later, Respondent recorded in the clinical record that Patient FH. was “doing better” with the temporary denture. 26. At an appointment on or about February 4, 2014, Respondent again noted that Patient FH. was healing within normal limits. 27. However, on or about February 10, 2014, Respondent noted that Patient RH. was experiencing “sore spots” on the anterior maxillary area. She performed an adjustment to the denture. 28. On or about April 18, 2014, Respondent noted in the clinical record that the area of teeth numbers 8 and 9 had gingival irritation which Respondent believed may be a fistula. Respondent had a radiograph taken of the area and noted possible implant failure. 29. The radiograph taken on this date showed significant bone loss present in the area of teeth numbers 9, 10 when compared to radiographic images taken at the time of implant placement on or about December 17, 2013. 30. At the April 18, 2014, appointment, Respondent planned to uncover the implants and place healing collars at the next appointment and continue with the restoration of Patient F.H.’s maxillary implants. A parenthetical note stated that Respondent planned to “proceed with restoring or place more implants” at the next appointment. 31. On or about May 16, 2014, Respondent uncovered the implants and informed Patient F.H. that he would most likely lose the implant in the position of teeth numbers 8, 9 due to “bone loss.” 32. At the following appointment of on or about May 23, 2014, Respondent noted that the area of teeth numbers 9 and 10 was “still sore,” and she would need to remove one or both of the anterior implants in these positions. 33. According to the clinical record for May 30, 2014, despite the concerns for the prognosis of the implants from the previous week, the anterior implants were now noted to be “integrated,” with the previous gingival swelling and discomfort having subsided. Respondent took an impression for the new overdenture. 34. According to the clinical record for June 13, 2014, Respondent noted difficulty with the path of insertion of the implant abutments. At the following appointment on or about June 27, 2014, Respondent was able to place the abutments and took an impression of the housing for the overdenture. 35. From on or about July 18, 2014, to August 29, 2014, Respondent made at least four attempts to try-in the new overdenture. 36. According to the clinical record for August 29, 2014, Respondent delivered the overdenture to Patient F.H., but advised that the prosthesis type may need to change. Respondent had the unfinished case forwarded to a colleague at another practice location for evaluation. 37. This was Patient F.H.’s last date of treatment with Respondent, who subsequently changed practice locations. 38. Following placement of the implants, Respondent proceeded to attempt restoration with the overdenture despite available evidence. of significant bone loss occurring during this time. 39. On or about October 7, 2014, Patient FH. sought a second opinion on his treatment. According to the evaluation performed by the subsequent dentist, it was noted that Respondent had failed to restore the overdenture and that Patient FH. was still wearing the temporary denture that lacked a palate. A radiograph taken on that date showed that four of the six implants placed by Respondent had failed. The remaining two implants subsequently failed. 40. Section 466.028(1)(x), Florida Statutes (2013-2014), states that “[bJeing guilty of incompetence or negligence by failing to meet the minimum standards of performance in diagnosis and treatment when measured against generally prevailing peer performance[,]” shall constitute grounds for disciplinary action by the Board of Dentistry. 41. Respondent violated Section 466.028(1)(x), Florida Statutes, in one or more of the following ways: A. _ By failing to utilize appropriate diagnostic imaging and testing when she developed the treatment plan for surgery and impiant placement; B. __By failing to identify or provide any evaluation of the radiolucency present during her treatment of Patient FH.; C. By failing to make appropriate adjustments to Patient F.H.’s temporary denture so as to not compromise the implants; or . D. By failing to adequately monitor Patient F.H.’'s condition following implant placement and provide appropriate treatment in response to the significant bone loss which occurred, WHEREFORE, Petitioner respectfully requests that the Board of Dentistry enter an order imposing one or more of the following penalties: restriction of practice, imposition of an administrative fine, issuance of a reprimand, placement of Respondent on probation, corrective action, refund of fees billed or collected, remedial education or any other relief that the Board deems appropriate. SIGNED this ]i** day of Qui. 2017. Celeste Philip, MD, MPH Surgeon General and Secretary Baidget th We Hermeds. Bridget K! McDonnell Assistant General Counsel DOH Prosecution Services Unit 4052 Bald Cypress Way, Bin C-65 Tallahassee, Florida 32399-3265 Florida Bar #099874 TEL: 850.558.9872, FAX: 850.245.4684 Express Mail Address: 2585 Merchants Row, Suite 105 Email: Bridget.McDonnell@fihealth.gov ILED DEPARTMENT OF HEALTH DEPUTY CLERK CLERK Amber rereene DATE yt 1 1 v7 vce. YW W017 PCP Members: Dr. J, Thomas; Dr. C. Miro; Dr. W. Robinson DOH v. Loryn Rene Mertill, D.D.S,, DOH Case #2016-16543 10 NOTICE OF RIGHTS Respondent has the right to request a hearing to be conducted in accordance with Section 120.569 and 120.57, Florida Statutes, to be represented by counsel or other qualified representative, to present evidence and argument, to call and cross-examine witnesses and to have subpoena and subpoena duces tecum issued on his or her behalf if a hearing is requested. A request or petition for an administrative hearing must be in writing and must be received by the Department within 21 days from the day Respondent received the Administrative Complaint, pursuant to Rule 28-106.111(2), Florida Administrative Code. If Respondent fails to request a hearing within 21 days of receipt of this Administrative Complaint, Respondent waives the right to request a hearing on the facts alleged in this Administrative Complaint pursuant to Rule 28-106.111(4), Florida Administrative Code. Any request for an administrative proceeding to challenge or contest the material facts or charges contained in the Administrative Complaint must conform to Rule 28-106.2015(5), Florida Administrative Code. Mediation under Section 120.573, Florida Statutes, is not available to resolve this Administrative Complaint. NOTICE REGARDING ASSESSMENT OF COSTS Respondent is placed on notice that Petitioner has incurred costs related to the investigation and prosecution of this matter. Pursuant to Section 456.072(4), Florida Statutes, the Board shall assess costs related to the investigation and prosecution of a disciplinary matter, which may include attorney hours and costs, on the Respondent in addition to any other discipline imposed. DOH v. Loryn Rene Merrill, D.D.S., DOH Case #2016-16543 11

Docket for Case No: 18-000917PL